Tuesday, September 29, 2009

Children get sick of being asked to talk or “perform” and may refuse, especially if your request for language seems purposeless to them. Games are a fun way for children to learn without even knowing they are learning. Newton (2004) discusses some key things to think about when deciding on what games to play. I discuss some of these below. But the key thing to remember is that, while learning to label things is important:“Action words are more important than nouns or names because they are far more useful. Names can only be used for labelling.” p113

Sounds or words?

Words will be meaningless sounds to our children if we don’t help them understand those sounds. Some fun ways to help children recognise the meaning include:* Sorting games – to help children recognise colours and understand descriptive words such as big and small, wet and dry, play sorting games. This could be a simple as getting them to find all the blue pegs while you are hanging the clothes on the line. Or sorting counters during Maths activities at school.

* Nonsense words – one of the things I use to prompt reluctant talkers to get involved is use nonsense or incorrect words to label or describe things that you are pretty sure the child is able to identify. For example, when reading a book identifying a dog as an elephant. Or if the child is requesting something, make wildly incorrect, humorous guesses until they correct you. And, from my experience, it usually brings laughter as well as the desired communication.

Which comes first? The request or the manners?

Newton (2004) suggests that it is much more important that your child learn to request something (eg. drink, biscuit) than learning “please” and “thank you”. However, once they have mastered the requesting, then you might want to teach these words. Some fun ways to expand on your child’s ability to request items:

* Hide and seek using an object – This will give you an opportunity to model and prompt requests.

* Sharing toys – play games where you limit the number of toys available so that you and your child, or the child and other children, have to request items and take turns. Or put toys just out of reach so that your child needs to ask for them.

Dramatic play, puppets and soft toys

Acting out every day activities in dramatic play can really help expand children’s language. Puppets, dolls and soft toys can also be a front behind which a child can “hide” if they are reluctant talkers. A child who will not talk with others may sit for hours “chatting” to or through their dolls, puppets and soft toys.* Shopping – just like with many of us adults, shopping can be a favourite with children. Set up a sales counter, use picnic sets, toys, empty cartons and play money and you will have many opportunities for speech. In this game children will need to request things. You can also help them with counting and other phrases that might be used in real life shopping experiences. Also, take every opportunity to describe what you, other children or the child is doing.

* The sandpit – playing in a sandpit will also product a lot of opportunities for communication. Building roads, castles, villages, cakes…. So many different opportunities for requesting and describing activities will be made.

* Cubby houses – cubby houses also seem to be one of those things that hold their appeal across the ages. And some of the most exciting, communication producing cubbies are the ones built out of mum’s bedspread, pillows, chairs, the dining table etc. Again, requesting, describing and using useful “real life” language in a pretend setting can help increase children’s communication abilities.

Cooking together

There are some household or life activities that lend themselves to helping children communicate. Cooking is one of these. It provides you with opportunities to describe what you are doing, talk about the ingredients, request items and so on.

Drawing and craft

Drawing, painting and craft projects are also productive of similar opportunities as described for the cooking activities. Here are some tips:

* Rather than guess what your child has drawn, try saying “Tell me about your picture.” Write down what the child says, either on the back or on the picture itself, so you can read it together and talk about it again another time.

* As you do these activities, talk about what you are doing. Eg, “Snip, snip! We are cutting in a straight line!”

Giving instructions

Play games where children provide instructions verbally. For example, Simon says (replacing “Simon” with the child’s name), treasure hunts, obstacle courses. But make sure you have pictures and gestures lined up for the child to use as well as language if they are struggling with their words.

Saturday, September 26, 2009

Newman (2004) also discusses how books can be used to help with language development. Based on her recommendations, here are some guidelines to help you with choosing and using appropriate books. I will use my book, Dave is Brave, to illustrate these as it was written and illustrated with these guidelines in mind.

1- Start with books that have clear and expressive pictures.The reason for this is that children are engaged or their attention is grabbed by things that interest or attract them. Colourful and clear pictures mean that the child does not have to be concentrating on the book to have their eye attracted to it. Colour and clarity catch the “corner of their eye”, so to speak.

Pictures will also give you the opportunity to label items and ask questions to prompt language attempts. If the child is interested and engaged by the pictures, they are more likely to attempt to communicate about the book, whether it be through gesture or speech.

2- Use books that show characters doing everyday, familiar things.

Books about unfamiliar topics will mean that the child is not able to use their prior knowledge or experiences to identify appropriate words that they might be able to use. If the content is familiar, through the reading process the child will learn words that will help them function or participate in their everyday life activities.

You can also develop your own books by taking a sequence of photos of everyday routines. These books can be a great resource to help expand your child’s vocabulary.

Talk about the pictures, suggest things that the people in the pictures might be saying, ask your child to label objects or identify what the person is doing. If your child’s language is developing, start asking them less obvious questions such as how they think the people in the photo might be feeling.

The activity plans that are sold in the Dave is Brave pack provide you with questions that will not only help develop your child’s language, but also their emotional intelligence. That is, it will help them understand what is going on socially and emotionally, and will prompt them to use language that will help them express this in everyday, real life.

3- Simple stories with few words and lots of repetition are especially good.As mentioned in a previous post, repetition is a great tool for helping children develop language through imitation and modelling. A book with rhythm and rhyme can also help prompt memory of sounds and phrases.

Dave is Brave is written with this in mind. For example, the text is written with the frequent repetition of the phrase, “Golly was a bully, but Dave was brave.” The text is also rhythmical:“Golly was a bully when he didn’t act like a friend.”

When interacting with the book, Newman (2004) suggests firstly that you read the book normally, with natural expression in your voice.

Next, ask questions of increasing difficulty depending on the child’s level of language development. Educators often talk about the different levels of questioning as “here, hidden and in the head.”

For example, looking at this picture from Dave is Brave:“here”: What did Dave say?“hidden”: How do you think Dave is feeling?“head”: Is Dave a boy or a girl?

Thirdly, there may be times whey you will need to paraphrase books to make sure that your child understands the language. This relates to your family or classroom language culture – the words you use to describe something may be quite different to those used in another family/classroom.

Finally, get the child to anticipate or guess what words comes next. And example of this is the cloze activity that is part of the listening games on the Dave is Brave music CD. What I do is pause to encourage the listener to say some of the repeated words for me. The rhyme also helps with this.

Tuesday, September 22, 2009

This post extends on the previous one, which discussed Newman’s (2004) advice for talking to your child who has communication difficulties. I want to focus in this post on her ideas about how to react when your child responds to you to ensure more communication attempts on their part.

1- “Respond immediately and positively” (p108)

Praise any attempts, even if they are not correct. Also, use “active listening” skills to ensure your child feels rewarded for their communication attempts, and to clarify meaning if you are unsure what they mean.

Active listening, according to Friswell, involves first stopping all other activity and intently focusing your attention on your child.

Second, look at the child – make eye contact, get down to their level by kneeling beside them if necessary.

Third, listen without interruption. Children struggling with communication may need more time to produce speech. Wait patiently, without rushing them or trying to finish their words or sentences. However, you may need to make encouraging sounds (uh-huh?) or use body language such as smiles and nods to give immediate feedback and encourage your child to persist with their communication attempt.

Finally, once they have finished, respond. In responding, make sure you focus on the positives first. A good rule to go by is: praise then re-phrase.

This allows your child to confirm their meaning using a nod or shake of the head.

2 – “Be over the top in your response” (p109)

To begin with, it can be important to get overly excited about communication efforts alongside providing immediate rewards for any communication attempts. This Utube video has a good illustration of this, though the communication is using the PECs system rather than words.

However, be conscious that for some older children struggling with communication over-the-top praise can be received negatively as they may feel you are drawing undue attention to their difficulties. Like with everything, be tuned in to what motivates your child or student and respond accordingly.

3 – “Don’t correct pronunciation or what she has said” – re-phrase instead.

This is a widely accepted approach.

For example:Jilly says, “Want duce in up.”Adult responds, “Very good, Jilly. You want juice in your cup?”Jilly nods. Adult provides her with juice in her cup.

However, the Lindamood program has suggested that correction of pronunciation is important. This links in with the importance of directly teaching children with disabilities new skills, rather than expecting them to simply “pick up” these skills through indirect modelling. It is also about children experiencing communication in a multi-sensory way – feeling and seeing sounds as well as hearing them. And, further, it is about helping children break down and sequence sounds in words. The program encourages children to look at the shape of the mouth, to feel how the tongue, lips and breath create the sound alongside simply hearing sound.

Saturday, September 19, 2009

Newman discusses a series of things you need to consider when talking to your child who has communication difficulties. Here is my summary of her advice, and some hints about how you can achieve these:1- Get your child’s attention – which usually means eye contact.For children with sensory integration issues, pointing their ear towards you may be there way of paying attention. Or you may want to hold their hand and wait until they are still before you speak.

2- “Speak clearly and simply using natural intonation.” p107Exaggerating expression or speaking/yelling loudly will not help your child to understand, even if they have a hearing impairment. It will only distort the sounds. Using inappropriate volume will also mean that your child will not learn about the different use of intonation and volume for different contexts. Eg. you might talk loudly outside, but use what teachers may call an “inside voice” indoors. You yell when you are angry or warning others, but speak calmly or with a smile in your voice in play situations.

3- “Repetition and consistency is very important.” I addressed this in the previous post.

4- Talk about everyday events and experiences, such as favourite games, videos, dinner, bathing and so on. Newman (2004) states, “Give her the language for what she is doing: ‘You are having a bath.’” (p107). If you repeat this regularly, your child will learn to connect the language with the experience.

5- Talk about the things your child is interested in. Watch what your child is looking at and label it, describe it. We have probably all done this with our very young children – “Look at that cow! Mooo! Moooooo! It is eating grass!”

6- Make sure your child can use the context to help them understand what you are saying. So if you are at the dinner table and you want to talk about what has happened during the day, make sure you have some cues such as photos.

7- Use body language to support your words. Use natural gestures to reinforce words, such as waving to reinforce the words “Bye-bye.” Makaton signs were designed for this purpose.

8- Pause and maintain eye-contact to encourage your child to respond. It may take longer for your child to process what you have said, and produce a response.

… I will talk more about helping promote children’s responses in my next post.

Reference:Newman, S. (2004). Stepping Out: Using Games and Activities to Help Your Child with Special Needs. London: Jessica Kingsley Publishers.

Tuesday, September 15, 2009

“Repetition and consistency is very important.Repeat things as often as you can so that she learns the association between the object and the sound. It may take a very long time, with seemingly constant repetition of simple words and ideas, but it really important that you persist. Try to be consistent with the words you use for objects; for example, decide on your family word for toilet/loo/lavatory/bathroom.” (Newman, 2004, p107).

When I first met Isaac* I was warned that I would have to look out for him. He was very rough with other children, pushing, shoving and grabbing toys. I was told that all the disciplinary measures (eg time out, praise, encouragement) were not working. And staff at his preschool were concerned because he was due to go to school next year.

Isaac had a cochlea implant, implanted when he was two years old. Having a cochlea implant does not mean that the child is then “cured” and everything is fine. There will be some delay in terms of language experiences and vocabulary learning missed in the very early years. Further, while a cochlea implant enables a child to hear, it does not act in exactly the same way as our ears (Moore, 1997). For children learning to “listen” with cochlea implants it can be hard to differentiate between important sounds (eg. the words of someone talking directly to you) and unimportant sounds (someone talking close-by or other background noises).

So Isaac had difficulties with learning how language worked in social situations. He saw children sharing, children joining in each other’s play, children interacting. He wanted to be part of this. But he wasn’t picking up the important phrases that made the play work. The give-and-take of social language was difficult for him to catch. It was too quick, there was too much background noise and movement to distract him, and the actual words used weren’t always the same.

So instead of asking to share toys, he would take them. To him, it looked like this is what other children were doing.

Instead of asking if he could join in a game, or call a child’s name to get their attention, he would bump into them, or pinch them, or hit them. Not to hurt, but to get their attention.

And, while he was told not to do this, he didn’t know any other way to achieve the same thing. And his speech was often hard to understand as he was still learning how to articulate them clearly.

But, taking ideas from his speech therapist and early intervention teacher, we worked out a way to help change Isaac's behaviour.

Whenever Isaac went to barge into children’s games, we would jump in and follow this routine:

- Stand beside Isaac and draw his attention by putting a hand on his arm.- Draw his attention to your mouth by first putting your open-palmed free hand to his chin, then bringing it back to your chin.

- Model how to get another child’s attention by looking at them and calling their name.

- Get Isaac to mimic this by bringing your open-palmed hand to his chin and saying, “Your turn!” and repeating the name.

- Repeat the process until the peer responds (use a physical prompt like tapping the peer on the shoulder to speed up the response if Isaac is beginning to lose interest).

- When the peer looks at Isaac (or yourself), bring Isaac’s attention to this by using the open-palm gesture as described previously.

- Then get Isaac to pay attention to your mouth using the open-palmed gesture.

- Model the words, “[peer’s name],Can I play?” [use exactly the same words every time]

- Get him to repeat this through the same process identified above

- Then get him to repeat it again whilst making eye-contact with the peer by drawing his attention to them using the open-palm gesture, then repeating the phrase, “[peer’s name], can I play?” and then saying, “Your turn!”- Give lots of praise for his attempt, encourage the peer to respond.

- If the child says, “Yes” help Isaac get involved in the play appropriately. If the child says, “No” re-direct Isaac to a different game. This will be a natural reward for his language attempts.

This process took a little while for Isaac and his peers to get used to, but we persisted and did the same thing all the time, with specific care to keep the words and gestures exactly the same. This repetition helped Isaac understand.

And we were amply rewarded.

One day I was watching and playing with the children on the playground and distinctly heard Isaac say, “Can I play?” I watched as he persistently repeated this and kept moving to where his peer could see his face until the peer responded. Luckily, the answer was, “Yes”. And Isaac joined in with no help from an adult.

*While this story is built from my experiences with children who have hearing impairments, the names and some details have been changed.

Reference:

Moore, B.C.J. (1997). An Introduction to the Psychology of Hearing. Academic Press: San Diego.

Newman, S. (2004). Stepping Out: Using Games and Activities to Help Your Child with Special Needs. London: Jessica Kingsley Publishers.

Friday, September 11, 2009

Hi Amanda - I thought I'd get in early with a question for you - I am exploring the idea of adapting a PECS system to help Hannah cope in an inclusive classroom. Can you suggest some ways to introduce her to this, also how would it work in a classroom? ( Is it really that easy for a teacher to and child to use? it is the one I am considering because my experience is that teachers rarely ahve the time to learn signing and then use it consistently) Also - what should I include in it eg are there categories that are commonly going to be useful in kindy? Anecdotally I have heard parents say that using this system has helped their children increase utterance length due to the sentence strip. I have access to the 2008 pecs cd - if I find it is working I will probably consider buying an updated version - next year. Thanks a lot. Shelley of Mainstream Musings(using Kit's private blog address cos I am not very technologically able - sorry!

What is PECS?

First, for those who aren’t familiar with the term PECS, it stands for Picture Exchange Communication System. The most common picture system used in schools is Boardmaker, with more and more schools actually purchasing the CD for use in their inclusive classrooms. See Spectronics for more information.

However, for families this system is not always affordable. There are other picture systems that have been developed, but if you want some free downloads you can visit Visual aids for learning, Sparklebox and do2learn. Both of these sites have free, downloadable pictures of commonly used concepts at home and at school.

How are PECS used?

The idea behind PECS is that by using concrete objects (pictures), the child can communicate without having skills such as eye contact and shared attention (paying attention to the same thing as the person they are communicating with, and taking turns in conversation) (Charlop-Christy, Carpenter, Lee, LeBlanc, & Kellet, 2002). These abstract skills can be taught in a very concrete, hands-on way using the pictures.

For example, if you are finding it difficult to get your child to pay attention to what your are saying, giving them a picture can help focus their attention. If the child is trying to communicate something, but is struggling to engage in the give-and-take of conversation, exchanging pictures can be like using a “talking stick”. In this way, they are getting your attention, and you are able to respond to their needs.

Pictures can be used instead of speech, but are usually used to supplement speech. PECS has been shown to be effective in helping children develop increased vocabulary and functional communication (Charlop-Christy et al., 2002). That is, children develop the ability to communicate their needs, wants and feelings in a way that helps them participate throughout the day with fewer “meltdowns” due to the frustration of not being able to communicate.

PECS is used for children with a wide variety of difficulties, including children with Down Syndrome and Autism.

a) Put things out of reach so that the child has to request the object:Make sure you have the picture card readily available. Do this as a game, and be prepared with extrinsic rewards such as stickers if necessary so that it does not become distressing for both the child and yourself. But the aim is to arrive at a place where getting what they want or need, and a hug or a smile is enough to make the activity rewarding for your child.

For example, if you want to teach your child to request to use the toilet (an important skill for school participation), first shut the toilet door. Assuming your child can’t open the door for themselves, that is. Then, blu-tack the picture representing the toilet to the door, making sure it is within easy reach of your child. Praise your child and immediately open the door when they point to, touch or pull the picture off the door and give it to you.

b) ModellingContinuing with the above example, have everyone in the house use the same technique. When you want to go to the toilet, give your child the picture of the toilet before you open the door. This means that she will learn to apply the “word” to others, not just herself. And whenever you use the card, say the phrase, “I need to go to the toilet.”

c) RepetitionDon’t vary this routine, right down to what you say. Get her to try to say exactly the same thing every time she uses the picture as well. If you repeat the same phrase, it will become familiar. Your child will also be able to practice and develop an “imprint” of that phrase in their memory – this it will help the shaping of the sounds with their mouth, their hearing of the sounds and their understanding.

d) Prompt and waitYou may also need to have a phrase and a gesture that will help prompt her to use the picture and/or language. Again, this phrase should remain the same … and pass this on to the teacher of her inclusive classroom. Make it something simple, like pointing to the picture and saying, “What do you say?” Then give your child a minute or so to process what you have said, and have a go. If she is getting distracted, use the same gesture and phrase again. Repetition and familiarity with the prompt are important, though at first you may need to use more physical prompts like guiding her hand to touch the picture. But gradually, try and reduce the prompts you give.

How is it used in the classroom?

PECS, especially boardmaker, is used in a number of ways in schools.

Individual communication booklets:This is where the child carries around a little booklet of key pictures in their pocket, or on a key ring clipped to their waistband. Here is an example from http://www.autismshopper.com/page8.html.

At school the communication booklet usually has pictures of key people, such as their teacher; self-help words, such as “toilet” and “hungry”; and emotions, such as happy or sad. They may also have pictures that represent key timetable features such as lunch, class and playground time.

Timetables and transitions:Becoming more common are velcro timetables. This is where pictures representing the different activities of the school day are stuck to a strip of velcroe either to the board at the front of the room, or to the child’s desk. Each time a task is finished, the picture is taken of the strip. Therefore the child can keep track of what is going on. This benefits all children in the classroom.

PECS can also be used to break up and teach the steps in specific activities. See an example on the Spectronics website.

Rules:The differing social demands of school can be quite challenging for the child. Therefore, PECS are often used to communicate the teacher’s expectations. For example, when sitting on the floor in front of the teacher the expectation is to sit quietly and keep your hands to your self. The teacher may stick the appropriate picture reflecting this on the board. They may also give a smaller version of the picture to the child to gain the child’s attention, then give a verbal prompt (shhh) and gesture (finger to lips). This really helps with the transitions and interactions that are an essential part of the school day. See and example here.

Social stories:The example in the link above is also a demonstration of how PECS can be used also to develop social stories which will teach children skills to cope with the different social challenges of the school day. I discussed this in a previous post.

In sum, the most commonly used categories at school are:

Self-care, including words such as toilet, food, drink, hurt

Timetabling and transitions: desk work, circle time, craft, sport and so on.

PECS may also be used during literacy activities to develop story strips, as seen on the right. These are Boardmaker symbols.

Just a note about sign language: Makaton

Makaton sign language (they have a PECS too) is becoming more common within inclusive classrooms as it is based on natural gestures rather than finger spelling. For example, the natural good-bye wave is used for “good-bye”. The “T” that we use in a “time-out” gesture for basketball is used to signify the need for a toilet break.

Check with your school – you might find that these simple gestures can be used for some key phrases. They can be taught in the same ways as your would teach PECS.

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